2006 proposed fee schedule - American Society of Clinical Oncology

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ADDENDUM B: RELATIVE VALUE UNITS (RVUs) AND RELATED INFORMATION Physician work Facility PE RVUs 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 3 +Indicates RVUs are not used for Medicare payment. Malpractice RVUs Nonfacility Total CPT 1 / HCPCS 2 Mod Status Description RVUs 3 Non-facility Facility PE RVUs Total Global 24115 A Remove/graft bone lesion 9.64 NA 7.02 1.67 NA 18.33 090 24116 A Remove/graft bone lesion 11.81 NA 8.78 2.05 NA 22.65 090 24120 A Remove elbow lesion 6.65 NA 5.74 1.10 NA 13.49 090 24125 A Remove/graft bone lesion 7.90 NA 6.05 1.06 NA 15.01 090 24126 A Remove/graft bone lesion 8.32 NA 6.82 1.16 NA 16.30 090 24130 A Removal of head of radius 6.25 NA 5.82 1.04 NA 13.11 090 24134 A Removal of arm bone lesion 9.74 NA 8.50 1.64 NA 19.88 090 24136 A Remove radius bone lesion 8.00 NA 7.04 1.38 NA 16.42 090 24138 A Remove elbow bone lesion 8.06 NA 7.53 1.34 NA 16.92 090 24140 A Partial removal of arm bone 9.19 NA 8.71 1.51 NA 19.41 090 24145 A Partial removal of radius 7.59 NA 7.71 1.25 NA 16.54 090 24147 A Partial removal of elbow 7.55 NA 8.23 1.30 NA 17.08 090 24149 A Radical resection of elbow 14.21 NA 11.28 2.34 NA 27.82 090 24150 A Extensive humerus surgery 13.28 NA 9.69 2.32 NA 25.28 090 24151 A Extensive humerus surgery 15.59 NA 11.17 2.59 NA 29.36 090 24152 A Extensive radius surgery 10.06 NA 7.49 1.48 NA 19.04 090 24153 A Extensive radius surgery 11.54 NA 5.91 0.74 NA 18.20 090 24155 A Removal of elbow joint 11.73 NA 8.15 1.92 NA 21.80 090 24160 A Remove elbow joint implant 7.84 NA 6.68 1.30 NA 15.82 090 24164 A Remove radius head implant 6.23 NA 5.58 1.03 NA 12.84 090 24200 A Removal of arm foreign body 1.76 3.26 1.59 0.20 5.22 3.55 010 24201 A Removal of arm foreign body 4.56 9.27 4.11 0.72 14.55 9.38 090 24220 A Injection for elbow x-ray 1.31 3.46 0.46 0.08 4.85 1.85 000 24300 A Manipulate elbow w/anesth 3.75 NA 5.52 0.65 NA 9.92 090 24301 A Muscle/tendon transfer 10.20 NA 7.93 1.66 NA 19.79 090 24305 A Arm tendon lengthening 7.45 NA 6.49 1.15 NA 15.10 090 24310 A Revision of arm tendon 5.98 NA 5.40 0.96 NA 12.34 090 24320 A Repair of arm tendon 10.56 NA 7.54 1.73 NA 19.83 090 24330 A Revision of arm muscles 9.61 NA 7.63 1.60 NA 18.84 090 24331 A Revision of arm muscles 10.65 NA 8.40 1.77 NA 20.82 090
ADDENDUM B: RELATIVE VALUE UNITS (RVUs) AND RELATED INFORMATION Physician work Facility PE RVUs 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 3 +Indicates RVUs are not used for Medicare payment. Malpractice RVUs Nonfacility Total CPT 1 / HCPCS 2 Mod Status Description RVUs 3 Non-facility Facility PE RVUs Total Global 24332 A Tenolysis, triceps 7.45 NA 6.56 1.23 NA 15.24 090 24340 A Repair of biceps tendon 7.90 NA 6.76 1.36 NA 16.01 090 24341 A Repair arm tendon/muscle 7.91 NA 7.68 1.36 NA 16.94 090 24342 A Repair of ruptured tendon 10.62 NA 8.25 1.85 NA 20.72 090 24343 A Repr elbow lat ligmnt w/tiss 8.66 NA 7.89 1.43 NA 17.98 090 24344 A Reconstruct elbow lat ligmnt 14.01 NA 11.16 2.36 NA 27.53 090 24345 A Repr elbw med ligmnt w/tissu 8.66 NA 7.78 1.44 NA 17.87 090 24346 A Reconstruct elbow med ligmnt 14.01 NA 11.00 2.33 NA 27.34 090 24350 A Repair of tennis elbow 5.25 NA 5.40 0.87 NA 11.52 090 24351 A Repair of tennis elbow 5.91 NA 5.72 1.02 NA 12.65 090 24352 A Repair of tennis elbow 6.43 NA 5.97 1.10 NA 13.50 090 24354 A Repair of tennis elbow 6.48 NA 5.95 1.07 NA 13.50 090 24356 A Revision of tennis elbow 6.68 NA 6.10 1.11 NA 13.90 090 24360 A Reconstruct elbow joint 12.34 NA 9.17 2.05 NA 23.56 090 24361 A Reconstruct elbow joint 14.09 NA 10.24 2.18 NA 26.51 090 24362 A Reconstruct elbow joint 15.00 NA 9.75 2.60 NA 27.35 090 24363 A Replace elbow joint 18.50 NA 13.29 3.01 NA 34.80 090 24365 A Reconstruct head of radius 8.40 NA 6.97 1.41 NA 16.78 090 24366 A Reconstruct head of radius 9.14 NA 7.29 1.52 NA 17.95 090 24400 A Revision of humerus 11.06 NA 8.58 1.92 NA 21.56 090 24410 A Revision of humerus 14.83 NA 10.10 2.57 NA 27.49 090 24420 A Revision of humerus 13.45 NA 10.21 2.17 NA 25.83 090 24430 A Repair of humerus 12.82 NA 9.43 2.21 NA 24.45 090 24435 A Repair humerus with graft 13.18 NA 10.55 2.27 NA 25.99 090 24470 A Revision of elbow joint 8.75 NA 7.46 1.48 NA 17.69 090 24495 A Decompression of forearm 8.13 NA 8.34 1.18 NA 17.65 090 24498 A Reinforce humerus 11.92 NA 8.97 2.06 NA 22.95 090 24500 A Treat humerus fracture 3.22 4.99 3.57 0.50 8.71 7.29 090 24505 A Treat humerus fracture 5.17 6.69 5.24 0.89 12.75 11.30 090 24515 A Treat humerus fracture 11.65 NA 9.09 2.02 NA 22.76 090
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DEPARTMENT OF HEALTH AND HUMAN SERV
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2. By mail. You may mail written co
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Rick Ensor (410) 786-5617 (for issu
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service of the U.S. Government Prin
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4. Proposed Revisions to §413.170
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AGA American Gastroenterological As
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GAO General Accounting Office GPCI
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PLI Professional liability insuranc
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Initially, only the physician work
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This resource-based system was base
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effect in 1997, published on Novemb
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● Revised requirements for superv
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efinement of work RVUs; and solicit
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historical allowed charges. This le
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November 1, 2001 (66 FR 55246).) Th
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The CPEPs identified specific input
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codes that the RUC has not yet revi
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procedure: $27,305,408. In this exa
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as a whole. Indirect costs include
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● The unscaled indirect expense a
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BNF is applied to (multiplied by) t
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NPWP Step 2--Calculation of Charge-
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In Table 11, the scaled total direc
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TABLE 13--Budget Neutrality and Fin
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The following discussion outlines t
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exist, and suggests that the need f
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TABLE 14--Practice Expense Per Hour
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We believe that we have consistentl
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Due to the ongoing refinement by th
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indirect PE methodology is inaccura
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multi-specialty PEAC that were base
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the needed survey or other data or
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PERC/RUC recommendations for these
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eflect the typical number of cast c
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on comments received and additional
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We have reviewed the PE database an
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the ACR. We have accepted the follo
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● Clinical Labor for G-codes Rela
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proposed associated prices that we
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Supply Code Supply Description Unit
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● Supply and Equipment Items Need
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Code 2005 Description Unit Unit Pri
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Code 2005 Description Price EQ212 p
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Effective January 1, 2006, this pro
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challenge the validity of a new loc
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ones reconfigured). Yet we also rec
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The issue of payment locality desig
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specialties listed infrequently as
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for premium rating purposes. ISO co
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psychology to the nonsurgical risk
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to anesthesiology which is 2.84 rat
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103 However, as noted previously in
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● Category #1: Services that are
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G0270, G0271 and 97802 through 9780
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Group Medical Nutritional Therapy (
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111 furnished in the group setting
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CMS Review 113 As noted previously,
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system that permits the physician a
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117 associated with the provided se
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119 overlapping surgeries, the teac
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anesthesia programs that have arran
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123 Section 623 of the MMA also req
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125 hospital-based facilities; whil
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127 The next step would be to devel
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Drugs Second Quarter ASP +6 Percent
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131 independent facilities, to acco
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133
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distributed this over a total proje
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137 additional 0.7 percent addition
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139 billed drugs regardless of sett
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141 than 0.9000 are paid more than
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adoption of the new hospital wage i
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of geographic designations for purp
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and they may or may not be suitable
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the Medicare Geographic Classificat
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(2) Metropolitan Divisions Under OM
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153 applying revised composite paym
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ased on the labor components establ
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157 actual cost structure faced by
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159 ESRD facilities is 53.711, as s
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from the cost reports. To avoid dou
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from Worksheet A. The resulting mar
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(1) Hospital Data Used In this prop
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wage data ended. However, since the
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approach to phasing-in the proposed
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facilities that would receive lower
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173 wage index values and then simu
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175 Because Neighborhood Dialysis C
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177 detected through our receipt of
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179 CBSA Code Urban Area Wage (Cons
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TABLE 28--Proposed ESRD Wage Index
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● Extraordinary circumstances (§
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effect as long as the rate exceeds
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● Adding a definition of a “ped
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exception rate. The facility would
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their intermediaries. Current parag
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229 costs are reasonable and allowa
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231 revised paragraph, a facility w
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H. Payment for Covered Outpatient D
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calculation. We also discuss the su
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customers (for example, physicians)
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239 We believe the weighted average
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number of 11-digit NDCs sold for ea
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243 included in the template, it is
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current reporting format is an appr
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247 section 1847A of the Act for th
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each quarter at the following web s
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251 We also note MedPAC’s recomme
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costs and units. We seek comments a
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255 pays for DME and associated sup
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pharmacy activities required to get
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259 representing 42 percent of the
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261 basic pharmacy services such as
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seek comment on the potential impac
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265 overpaying for the costs associ
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267 and information about how pharm
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269 takes good faith efforts to res
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271 Specifically, we consider that
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supplies. Using billing data, we id
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70481 CT orbit/ear/fossa w/ dye 704
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K. Therapy Cap 73223 MRI joint uppe
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provided for an active subluxation
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is less than 2 percent of spending
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(2) entities determined by the Secr
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285 We are proposing a supplemental
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FQHC claim form to effectuate the b
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289 can issue a final determination
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291 conclude that Hispanic persons
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293 nuclear medicine services in ei
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adiopharmaceuticals. In the final r
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297 (including Nuclear Medicine and
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we would resolve any doubt on the m
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facility payment rather than a TC c
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ventures and leases, pose a risk of
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305 Underlying the projected rate r
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decisions are central to the health
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however. We are particularly intere
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The collection requirement in this
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eporting requirements are discussed
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IV. Response to Comments Because of
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achieve the objectives with less si
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319 The analysis and discussion pro
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321 for a new code may change becau
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323 TABLE 30--Impact of Practice Ex
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hour for these specialties. As note
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Both physical/occupational therapy
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329 proposing to add cardiology cat
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Speciality Impact of Removing Aberr
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Family TABLE 32--Impact of Multiple
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335 column includes the current est
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Specialty Medicare Allowed Charges
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339 Non-Facility Facility % % HCPCS
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341 have undertaken a similar analy
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of the updated GPCI data. For the R
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C. Medicare Telehealth Services In
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347 TABLE 37--Impact of Proposed Ch
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349 of the increase to the drug add
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plus current AAP priced drug paymen
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353 the center up to what it would
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satisfies the requirements of the i
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357 certainty the extent of these s
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delivery arrangements and would hel
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List of Subjects 42 CFR Part 405 Ad
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(including by refunding amounts in
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(2) Any financial incentives provid
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7. The authority citation for part
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* * * * * PART 413--PRINCIPLES OF R
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371 D. Redesignating paragraphs (l)
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Page 387 and 388: 1. CPT/HCPCS code. This is the CPT
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ADDENDUM B: RELATIVE VALUE UNITS (R
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CPT Code Short Descriptors 21480 Re
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CPT Code Short Descriptors 92284 Da
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Addendum D 2006 GEOGRAPHIC PRACTICE
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Carrier Locality Locality name Work
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Carrier Locality Locality Name 2006
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Addendum F ESRD FACILITIES- METROPO
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715 SSA State/County Code County an
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2006 proposed fee schedule - American Society of Clinical Oncology

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